Enterovirus confirmed in L.A. County

Public health officials on Wednesday announced that at least two children in Los Angeles County have contracted enterovirus D68, which is generally characterized by mild symptoms but has caused limb paralysis in some patients.

Speaking from Children’s Hospital Los Angeles (CHLA), Los Angeles County interim health officer Dr. Jeffrey Gunzenhauser said there is no treatment or vaccine for enterovirus D68.

“To put this in perspective: enterovirus infections are very common in children. Most infections of the enterovirus don’t result in any type of severe illness,” he said. “The illness normally occurs in the summer and in the fall, and typically involves children because they’ve not been exposed to — or have no immunity to — the infection.”

In August, a child developed symptoms of a mild respiratory infection, but one week later, the child woke up with acute limb weakness, Gunzenhauser said. He said the child had been admitted to CHLA.

Dr. Grace Aldrovandi, chief of CHLA’s Division of Infectious Diseases, said the child was between the ages of five and 10, and the patient was otherwise healthy prior to being admitted to the children’s hospital.

“It’s not normal,” she said. “It’s really rare. Millions of children in this country will be and have been infected with enteroviruses. We don’t understand why sometimes in some children enteroviruses attack the nervous system. We are not one hundred percent sure that this D68 is causing this, but there does seem to be a strong association.”

The child spent approximately three weeks in the hospital and has shown improvement, Aldrovandi said. However, the child still has limb “abnormalities,” she said. Some patients have recovered completely, while others have not shown much improvement, Aldrovandi said.

“We are optimistic that with time, this child will have greater recovery and hopefully a full recovery,” she said, adding that the child is no longer at risk of spreading the disease.

Aldrovandi said other children in the U.S. have been diagnosed with neurological problems as a result of contracting the virus. She said the hospital and the Los Angeles County Department of Public Health are working with individuals at the Centers for Disease Control and Prevention, as well as other scientists, to determine why the virus is associated with “such severe disease” in children at this time.

There are no U.S. Food and Drug Administration-approved medications or treatment, Aldrovandi said. However, the child received “state-of-the-art” treatment and supportive care at CHLA, she said.

Enteroviruses are a family of viruses, and there more than 100 strains, Aldrovandi said. She said polio is a member of the family, but the child’s limb weakness was not caused by polio, though the two diseases do share similar symptoms.

“Polio is not the only virus that can give you this type of paralysis. That’s why some people say this is a polio-like [disease], but it’s not polio,” Aldrovandi added.

She said there are a lot of enteroviruses circulating in the community, and most people will display no symptoms or mild symptoms. Aldrovandi said a small subset of adults and children develop neurologic symptoms.

The first enterovirus was identified in California in 1962, she said. Over the last few decades, there have been very few cases. In 2001, 49 individuals were stricken by an enterovirus; however, there are now more than 400 cases, Aldrovandi said.

“So we know that enteroviruses are circulating,” she added.

Aldrovandi said children with asthma are at a greater risk of severe respiratory manifestations, but they are not necessarily more likely to develop neurological symptoms.

She said she is hopeful that a vaccine or special anti-viral agents to combat the disease will be discovered soon.

Gunzenhauser said symptoms can include a runny nose, coughing, sneezing and, in some cases, fever. He said anyone who develops difficulty breathing should seek immediate medical attention. Gunzenhauser said patients can have trouble speaking and eating, and they may begin wheezing. Their lips can also turn blue, he said.

“However, this case is a great opportunity to remind folks there are specific actions that we can take to prevent the spread of infection such as this,” Gunzenhauser said, advising residents to always wash their hands with soap and water. “Simply doing that will eliminate the virus.”

Furthermore, people should refrain from touching their faces with their hands, disinfect potentially contaminated surfaces and stay home from school or work if they are ill, he said.

“All of these actions will help prevent the spread of this infection,” Gunzenhauser added.